Periodically, readers send me links to articles and/or posts by Psychiatrists that purport to diagnose various public officials. I wrote about one of the more egregious mis-uses of Psychiatry to pathologize one’s political opponents in my post on PsychBlogging and the Goldwater Rule.
Using Psychiatric diagnoses to discredit political opponents has a long pedigree. I can appreciate the tendency of so many non-professionals to use such terminology. Many people imagine Bill Clinton to be quite Narcissistic. While I might agree that Clinton’s behavior appears to fit the colloquial meaning of the word Narcissistic, ie he seems to be quite self-centered, with a volcanic temper when challenged and an overt insensitivity to how his behavior might affect those closest to him, that is a far cry from diagnosing him as exhibiting a Narcissistic Personality Disorder. NPD is a specific Psychiatric diagnosis which I reserve for those people whose inner world I have a certain specific entree into, who exhibit specific types of object ties in their most important relationships. I do not see how it is possible to make such a diagnosis without examining a patient in a setting specifically designed to elicit the requisite psychodynamic data. If anything, I attempt to be quite reserved in using such loaded terms as Narcissistic to describe a public figure, for fear it might be mistaken for my imprimatur on a Psychiatric diagnosis. (If I occasionally fail in this, it simply means I am human.)
Sadly some Professionals do not share my scruples. Psymon recently directed my attention to a posting at the Daily Kos, which diagnoses President Bush with a Narcissistic Personality Disorder. Paul Minot claims to be a Psychiatrist and occasionally posts on the Daily Kos diaries. His post on Bush’s NPD was quite popular, generating 746 comments.
Minot’s report highlights two problems with this kind of Mis-application of Psychiatry, one merely annoying and the other quite disturbing. The merely annoying problem with this kind of report is the exhibition by a so-called Mental Health professional of a marked ignorance of how Psychiatry works; this is a subset of the misunderstanding of what constitutes scientific evidence.
Minot fails to realize that manifest behavior is always the result of a compromise between various conscious and unconscious desires, drives, affect states, prohibitions, and reality demands. As a result, there are always multiple possible explanations for any person’s character traits and behavior. For example, Minot writes:
Bush knows that things aren't going his way in Iraq, and he knows that it is damaging him politically. He also sees that it is likely to get worse no matter what he does, and in fact it may be a lost cause. However, he recognizes that if he follows the recommendations of the ISG, that Iraq will almost certainly evolve into a puppet state of Iran, and given his treatment of Iran he will completely lose control of the situation--and he will be politically discredited for this outcome. The ONLY chance that he has to avoid this political disaster, and save his political skin, is to hope against hope for "victory" in Iraq. Advancing the "surge" idea offers Bush two political advantages over following the ISG recommendations. One is that if it is implemented, maybe, just maybe, he can pull out some sort of nominal "victory" out of the situation. The chances are exceedingly slim, granted, but slim is better to him than the alternative (none). Alternately, if the "surge" is politically rejected, he gains some political cover, so when things inevitably go to shit, he can say "I told you so" and blame the "surrender monkeys" for the outcome. Most people probably won't buy it, but some (his core base) will.
Now, I know what many of you are thinking--is George Bush willing to risk the lives of hundreds, maybe thousands more American soldiers, on an outside chance to save his political skin, in a half-baked plan that even he knows probably won't work at all? Damn straight he is. Because George Bush is that narcissistic, that desperate, and yes, that sociopathic as well.
A charitable approach to Minot’s article would suggest that he seems to confuse the concept of Psychic determinism with Psychiatric reductionism; as a result he never addresses any reality-based possibilities. Perhaps Bush is so concerned about the potential effects of failing in Iraq that he is willing to go the extra mile, trying to forestall a future disaster even at the risk of his current standing and legacy. Even if you prefer a more limited Psychiatric approach, as if one could ever fully explain a person’s political position by resorting to Psychiatric reductionism, there are also multiple possibilities which I will not dignify by enumerating.
The second more problematic issue is that Psychiatric diagnoses can be powerful weapons and can be extremely harmful if done in a careless or biased manner; Minot exemplifies this tendency. He attempts to start off with a reasoned and reasonable discussion but invalidates his argument by offering his conclusion in the second word of his post.
Bush's irrational consideration of a "surge" in the wake of the ISG report--which apparently defies all credible counsel--has begun to generate speculation regarding his sanity. References to Bush's "delusions" have appeared in the MSM (notable on "Scarborough Country") and throughout the blogosphere. As a psychiatrist, I understandably get concerned when I see clinical terminology bandied about in political discourse, and thought it might be of interest to share my own perspective on this question. Whiel the left has not yet begun to overtly recommend locking up their political opponents, there have been suggetsions made to silnece "global warming deniers" and there have been multiple attempts to pathologoize the current President’s policies.
First of all, let me state up front that I probably hate Bush as much (or nearly so) as anybody here. I think he has done more damage to our country than Osama Bin Laden ever did, and probably is the manifestation of OBL's most wicked fantasies following 9/11. Frogmarching him to the Hague (along with Cheney, natch) is too good for him. I think the guy is both stupid and evil, and I have no intention of cutting him any slack here. But in the political/clinical tradition of Dr. Bill Frist's school of diagnostics, I have a distinct clinical impression that I think explains most of his visible pathology. [Emphases mine-SW]
If I hate a patient, at a minimum, I am obligated to recognize that my intense counter-transferential response is likely to color how I perceive and interpret the material the patient supplies me. If I experience a transient feeling of hostility toward a patient, I may be able to use that feeling to help me understand what the patient is doing or what the patient contains within himself that has evoked such a response in me. I can then use that knowledge to help the patient understand himself. However, if I hate a patient and cannot find a way toward experiencing him in an at least neutral fashion, it is incumbent on me to refer the patient elsewhere. A Psychiatrist who attempts to diagnose a patient he hates is accepting behavior that is tantamount to malpractice.
[I purposely omit the case of a Psychiatrist consciously using his knowledge as a weapon, as I attempted to do in my psychological discourse on Ayman al-Zawahiri. If you are unable to see the difference in the two cases, I am afraid I cannot help you there.]
There is a more serious potential danger in this as well. Once political differences have become pathologized, we have entered a slippery slope that can lead to very dangerous outcomes. Those of us who are familiar with the mis-use of Psychiatry by totalitarian regimes like the USSR, which created a special diagnosis for dissidents are very sensitive to this kind of shifting of the frame of the debate.
["Slow Schizophrenia" was one of the diagnoses they used against dissidents. Obviously, anyone who publicly complained about the Worker’s Paradise was clearly psychiatrically disturbed and needed to be locked up and treated with powerful anti-psychotic medications.]
Recently the Chinese have taken a page out of the Soviet’s book on how to handle dissidents and has been locking up such psychiatrically disordered individuals at an accelerating pace. (See this and this.) The value, to the totalitarian, of diagnosing an opponent as Psychiatrically ill is that it obviates the need to actually address their arguments and avoids the messiness of a public debate on the merits of a particular policy.
[Apparently, according to Human Rights Watch, the Chinese have coined "evil-cult-induced-mental-disorder" for use against Falun Gong members. I suppose the diagnosis sounds more professional in Chinese.]
Just one more thing: perhaps Minot could respond to Ralph Peters, no friend of the Bush administration's conduct of the war, who believes we are already showing signs of the surge meeting with significant success. Does Minot think Peters is delusional, or as with any good Psychiatrist, is he willing to question his interpretations in the light of new data?
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